Panel Puts Off Mammography until Age 50

What breastcancer.org says about this article…

Panel Puts Off Mammography until Age 50

The U.S. Preventive Services Task Force is a group of experts that makes recommendations to the U.S. Department of Health and Human Services on policies to prevent diseases, including the best ways to use screening tests such as mammography to meet the health needs of the United States. The task force reviewed several studies and recommended dramatic changes to current breast cancer screening guidelines.

Based on its analysis, the the task force concluded:

• Screening mammograms for women at average risk of beast cancer should start at age 50, rather than at 40 as current guidelines recommend.
• Only women at very high risk of breast cancer should get screening mammograms when they're younger than 50.
• Screening mammograms should be done every other year instead of every year, as current guidelines recommend.
• There's not enough evidence to support teaching and encouraging breast self-exam.
• There's not enough evidence to encourage women older than 75 to get mammograms.

These conclusions are based on research that looks at the effect of breast cancer screening on society from a public health perspective. This means the researchers were looking at how changing breast cancer screening guidelines would affect the overall public, rather than individual women. The researchers looked at the medical records of tens of thousands of women screened for and diagnosed with and treated for breast cancer in the past. Using a computer model that took into account the medical data and assumptions about breast cancer diagnosis and treatment, they determined the benefits and risks of changing breast cancer screening guidelines.

The task force said that mammograms done on women age 39 to 69 DO save lives. Still, when the experts compared the number of lives saved by mammograms done in women younger than 50 to the cost of those mammograms (and the problems associated with false positives) they decided that the cost wasn't justified. A false positive is an suspicious area that looks like a cancer but turns out to be normal. Besides the fear of a breast cancer diagnosis, a false positive usually means more costly tests (including biopsies) and follow-up doctor visits. The process can be very stressful and upsetting. The studies analyzed by the task force showed that false positives are more common in younger women. The task force also said that the studies showed no evidence that breast self-exams saved lives, from a public health viewpoint.

While some doctors are concerned about the radiation exposure that women receive during annual screening mammograms, the task force experts didn't think that was a problem and radiation exposure wasn't a reason for suggesting changes to breast cancer screening recommendations.

Breastcancer.org doesn't agree with the recommended changes to breast cancer screening policies proposed by the task force. We feel that that model the task force used to develop the recommended changes isn't accurate and the conclusions are flawed:

• The analysis is based on older mammography techniques, meaning the researchers mostly looked at results from film mammograms instead of digital mammograms.
• The analysis was based on some inaccurate assumptions about optimal treatment after breast cancer is diagnosed. For example, it assumed that women diagnosed with hormone-receptor-positive, early-stage breast cancer would receive and benefit from hormonal therapy but not chemotherapy, even though we know that many of these women do receive and benefit from chemotherapy after surgery. Inaccurate assumptions such as this may have caused the researchers to underestimate the number of lives that would be lost should the proposed screening changes be adopted.
• The analysis didn't adequately consider the combined benefit of early detection (with current screening guidelines) and new treatments that have resulted in steadily improving survival rates in recent years. Screening cannot be looked at in isolation as a snapshot. Screening happens as we continue to improve screening techniques, diagnosis, and treatment. But we can't treat what isn't diagnosed.
• The proposed guideline changes would mean that many breast cancers would be diagnosed at a later stage, making it harder to become cancer-free. Later-stage diagnoses result in more women with metastatic disease (cancer that has spread to other parts of the body) and more women with large or multiple cancers requiring mastectomy (too late for lumpectomy).
• The proposed changes would mean that younger women would be diagnosed later. Breast cancer in younger women tends to be more aggressive, so early diagnosis and treatment is more critical for them. It is the lives and futures of younger women that would be lost if the proposed changes are adopted.

The task force estimated that 3% more women would die from breast cancer if the recommended changes were adopted. Expressed as nameless, faceless numbers, this 3% decrease in breast cancer survival might seem like an acceptable trade-off when compared to the economic benefits of changing breast cancer screening policies. But breast cancer affects a very large number of women, so 3% of that number is not insignificant. The reality is that more women -- mothers, daughters, sisters, grandmothers, and aunts -- will die each year from breast cancer, which is neither reasonable nor acceptable.

You may be confused about this news and what it means for you. Breastcancer.org suggests the following:

• Understand that this is still a recommendation that will likely be discussed. It's a scary discussion because it could mean insurance companies may not cover annual mammograms or mammograms at all for women age 40 to 49 at average risk. This could be a major step backwards in the fight against breast cancer. But right now, the current screening guidelines haven't changed and should be followed.
• The task force didn't say that screening mammograms are dangerous or should be avoided. The report specifically noted that the radiation exposure is acceptably low. This side debate shouldn't make you think that screening mammograms are bad and should be avoided. One of Breastcancer.org's greatest concerns is that women who should be getting screened won't because they're confused by or afraid of these new recommendations.
• Remember that healthcare decisions, including getting screening mammograms and doing breast self-exam, are personal choices you make based on the information available and your unique situation. A woman can choose to make breast self-exam part of her personal breast health monitoring and screening plan. Government recommendations and guidelines eventually may affect whether insurance companies cover screening mammograms or not. But this isn't true for breast self-exam, which costs only your time and commitment.
• Talk to your doctor about your family and personal health history and your individual risk of breast cancer. Together you can create a screening plan that makes the most sense for you and your unique situation.

You also might be interested in reading a note Dr. Marisa Weiss, Breastcancer.org's president and founder, wrote to our community, addressing the task force recommendations. Read Dr. Weiss' note.